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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: <br />3003 W. CA5iki5 Pb 61ali r BLL) t 4 <br />PROPERTY TAX # <br />PERMIT # <br />I ® -®3 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER (56VJWG <br />Phone/E-mail <br />Address PD 4 oY 3-lb-7 M I S D N-13 <br />City/State/Zip S W-rLE , WA 9 S i24 - 2 o'1 <br />APPLICANT: A Owner _ Owner's Agent _Contractor —Contractor's Agent _Tenant (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR S ' fI ' <br />State Lic. # juC.0 I' I C City Bus. Lie. # , .7o�y y <br />Address <br />fPh.ne/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />-JEPir bR.A%-M?, 'Y��-234_019 <br />Phone/E-mail JE.FFERW G, DRhll .X 0 90EING. COM <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK 001060 <br />Existing Use of Building M FL; <br />HEAT SOURCE: <br />Proposed Use of Building M I&V <br />Gas_ Electric_ Other_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family X Commercial <br />Type of project: New Addition , Remodel _Repair_ T.I. —Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />60w,; EST l j.1L' <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn <br />Show <br />_Alteration _Repair <br />Number (#) of fixtures <br />Type of Project: <br />Show <br />_New_Addn _Alteration _Repair <br />Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of this property to perform the work for which application Is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�el ei/i5 T�i% <br />OwneHAuthorizelAgent signature Date <br />L. <br />(Revised 312013) <br />